This difficult time may be complicated by a phenomenon known as the surge before death, or terminal lucidity, which can happen days, hours, or even minutes before a person's passing. Often occurring abruptly, this period of increased energy and alertness may give families false hope that their loved ones will recover.
This surge of energy is usually short, lasting anywhere from a few minutes to several hours, and may occur one to two days prior to death. This is unique to each person, and not everyone will experience such a noticeable burst of energy.
This period of perking up can be accompanied by such a notable change in mental clarity that hospice professionals have coined the phrase “terminal lucidity” to describe it. This change in cognition and behavior goes against everything families learn about the physical signs that the end of life is near.
The first stage is known as pre-active dying. A person will start to detach from social activities and spend more time sleeping. They will also lose appetite. Their bodies will find it hard to heal wounds.
Transitioning is the first stage of dying. It describes a patient's decline as they get closer to actively dying. Generally, when one is transitioning, they likely have days — or even weeks — to live. I have seen some patients completely skip the transitioning phase and some stay in it for weeks.
In the hours before death, most people fade as the blood supply to their body declines further. They sleep a lot, their breathing becomes very irregular, and their skin becomes cool to the touch. Those who do not lose consciousness in the days before death usually do so in the hours before.
Terminal restlessness generally occurs in the last few days of life. Around 42 percent of hospice patients experience agitation during their final 48 hours. But even more develop symptoms before then, which may not subside until death.
Terminal agitation is typically seen during the hours or days before death and can be distressing and overwhelming for caregivers.
Needing more sleep
Some people become completely unconscious for periods of time before they die - this could be for a short period or as long as several days. They may seem less interested in what is going on around them, and have less energy to take part, but this does not mean they can't hear you.
For approximately the first 3 hours after death the body will be flaccid (soft) and warm. After about 3-8 hours is starts to stiffen, and from approximately 8-36 hours it will be stiff and cold. The body becomes stiff because of a range of chemical changes in the muscle fibres after death.
Rigor mortis refers to the state of a body after death, in which the muscles become stiff. It commences after around 3 hours, reaching maximum stiffness after 12 hours, and gradually dissipates until approximately 72 hours after death.
Some argue that a rise of neurotransmitters could be released from the brain in response to deteriorating health. Others suggest that the body might be attempting to prepare for the final stages of life or that the surge is connected to the patient's emotional state.
This stage is also one of reflection. The dying person often thinks back over their life and revisits old memories.4 They might also be going over the things they regret.
They Know They're Dying
Dying is a natural process that the body has to work at. Just as a woman in labor knows a baby is coming, a dying person may instinctively know death is near. Even if your loved one doesn't discuss their death, they most likely know it is coming.
This can include wandering attention, aimlessness, and outbursts of emotion. There's no set type of terminal restlessness, however, and this can sometimes make it difficult or even impossible to predict how a patient experiencing symptoms such as terminal agitation may act.
Sudden muscle movements (called twitches) are often caused by medicines. Muscle twitches can be managed by making changes to medicines or the dose of a medicine. Muscle twitching can also happen as the muscles get weaker and when there are changes to blood flow.
The symptoms of terminal restlessness are common when a person is close to death. They may include agitation and aggressive behavior, or even an unusual sense of calm and reflection. There are many causes of terminal restlessness, such as pain, medications, and emotions about dying.
As the moment of death comes nearer, breathing usually slows down and becomes irregular. It might stop and then start again or there might be long pauses or stops between breaths . This is known as Cheyne-Stokes breathing. This can last for a short time or long time before breathing finally stops.
24 Hours Before Death Symptoms
You can use a normal speaking voice when talking to them. Many of the physical changes they have experienced for the past few months will become more pronounced. Their skin becomes increasingly mottled and blotchy, especially on the hands, feet and knees.
Individual experiences are influenced by many factors, including the person's illness(es) and medications, but there are some physical changes that are common. For some people, the dying process may last weeks; for others, it may last a few days or hours.
The brain is the first organ to begin to break down, and other organs follow suit. Living bacteria in the body, particularly in the bowels, play a major role in this decomposition process, or putrefaction. This decay produces a very potent odor. “Even within a half hour, you can smell death in the room,” he says.
Stage One: Stable
The first phase of palliative care involves designing and creating a treatment plan suitable for the patient's specific condition. The patient and their family will work closely with the care team to identify the physical and medical needs of the patient and who can best provide the necessary care.
Mottling of skin before death is common and usually occurs during the final week of life, although in some cases it can occur earlier.